The Causes of Incontinence in Women

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If you suffer from incontinence – involuntary urine leakage – you need to know that there are a number of different types of incontinence and a number of causes. This article will not only help you figure out what type you have, but also give you information about what might cause it and the tests a doctor might do.

The average adult bladder can hold over 350ml - 550 ml (2 cups) of urine. The ability to hold urine and control when you use the toilet depends on the normal function of the kidneys, bladder muscle and its controlling sphincter muscles, and the nervous system. In addition you need to be able to recognise and respond to the urge to pass urine.

Stress Incontinence:

If you have urine leakage when you cough, sneeze, laugh or exercise, then this is probably stress incontinence, also called a ‘weak bladder’.

When you cough, sneeze, laugh or exercise the stomach muscle contract and push down on the pelvic floor. This downward pressure causes the leakage by squeezing the bladder (and therefore its contents) against the sphincter muscle at its base. You don’t usually feel that you need to use the bathroom just before it happens and it usually just pushes out a small amount of urine.

The cause of stress incontinence or weak bladder is often a result of weight gain or pregnancy. The pelvic floor muscles are like a hammock that lies between the pubic bone at the front across to the spine at the back. The bowel, vagina and urethra from the bladder pass down through this hammock and it acts as a support for them. If these muscles become out of condition or stretched (through childbirth for example) then they can’t do their supporting role.

A chronic cough (from smoking for example) and the drop in oestrogen levels at the menopause can also make the problem worse.

If you have an overactive bladder, or urge incontinence you find that you’re passing larger volumes when urine leakage occurs.

An irritable bladder might be caused by one of 2 things. Either because the bladder can’t fill properly and particles in the urine irritate the bladder, causing it to contract. This is often called sensory urge incontinence.

Or because the bladder spasms at the wrong time and causes a strong urge to use the bathroom. This spasm can be caused by some neurological conditions such as a stroke or Parkinson’s Disease, or by some medications but a lot of time doctors don’t know its cause.

The symptoms of an irritable bladder include: needing to pass urine more than 8 times a day, waking in the night to use the bathroom more than twice, passing small volumes when you go, urine leakage when you have a strong urge to go.

Many women have a mixture of stress and urge incontinence – called mixed incontinence. The table below will help you determine which you have.

Stress or urge incontinence, or mixed?

Types of Incontinence

Other types of incontinence, which are less common, include:

Overflow incontinence happens with there is a blockage causing a urine leakage but you don’t feel any need to urinate. It’s uncommon in women.

Anatomical incontinence indicates that there is a problem with the bladder or urinary structures that mean you can’t pass urine properly. These may be present from birth or a result of injury.

Total incontinence means there is no control over urination and there is a constant leak of urine that you have no voluntary control over. It can occur when there is a nerve problem to the bladder such as in multiple sclerosis, spinal cord injury or a condition called neurogenic bladder.

Functional incontinence occurs when a person can’t get to the bathroom in time, often due to dementia or a mobility problem like arthritis.

Diagnosis of incontinence problems and bladder dysfunction will be made by your doctor after she has listened to your medical and gynae history and she may ask for/perform a few tests. These might include:

Pelvic exam and/or a rectal exam to determine how strong the pelvic floor muscles are and to feel the internal anatomy. For example, it may show if the bladder or urethra is bulging into the vaginal space.

Cystoscopy – examination of the inside of the bladder by a camera inserted via the urethra cyst

Pelvic or abdominal ultrasoundabdominal ultrasound

Post-void residual (PVR) to measure - measuring the amount of urine left after urination

Urodynamic studies measure pressure and urine flow

UrinalysisUrinalysis or urine culture to exclude a urinary tract infection

Urinary stress test (you are asked to stand up, with a full bladder, and then cough)

X-rays with contrast dye of the kidneys and bladder to see their internal structures

It might be a good idea to keep a diary of your symptoms for a few weeks before you see the doctor.

If you need to use incontinence pads, incontinence pants or briefs then you can avoid the embarrassment of the store by ordering online. Read the descriptions of each type of incontinence aid to find one that will suit you best and try a number of brands until you find one you like and feel confident with.